The Hope Center Blog

Case Study – Surgery

Nye, is a two year old female spayed Whippet mix who was referred to Hope emergency service by Norbeck Animal Clinic for lethargy, inappetence and a right sided thoracic swelling.

Presenting Complaint/History

Nye had been reluctant to go in and out of her owner’s truck for approximately three days prior to being seen at Norbeck Animal Clinic. The owner noticed a swelling on the right side of her chest the next day and was brought to be seen when she became lethargic and inappetent. Nye travels with the owners to Florida, and she was also in Tennessee three months ago. Nye also runs through the park and woods off leash and the owner does note that she has some superficial abrasions after such play.

Previous medical history

In the summer of 2014, Nye was hit by a car and sustained a hip fracture. All implants were subsequently removed. Nye also has a history of a spontaneous pneumothorax in December of 2014, which resolved without intervention.

Physical exam findings and assessment

Physical exam revealed an approximately 5cm diameter, firm, adherent, nonpainful swelling on the right lateral thoracic cavity at the level of the costochondral junction between ribs 9-12. Initial suspicion was an abscess and cellulitis with associated foreign body. Other rule outs included an atypical hernia or neoplasia. An ultrasound was recommended to further diagnose the condition.

Diagnostics

The ultrasound was performed by Hope Radiologist, Dr. Matthew Paek. His report identified a suspect small (~1.3cm in length), subcutaneous foreign body between the margins of the distal right 10th/11th intercostal spaces with moderate regional inflammation/cellulitis +/- abscessation.

Radiograph 3

Ultrasound Image of possible Foreign Body

Surgical exploration

Nye was transferred to the surgery department and the right lateral thoracic mass was explored. A large pocket of purulent material was located deep to the musculature. A sample of the fluid was collected and sent for culture. The tissues were thickened and inflamed. The muscles were incised to the level of the intercostal muscles between the 10th and 11th rib. Dr. Paek sterilely guided the ultrasound probe into the incision and the foreign body was noted directly on top of the pleura but not entering the thoracic cavity. The material was dissected out of the tissues and found to be approximately 1cm of barbed plant material. An active suction drain was placed and the tissues were closed routinely.

Radiograph 3

Plant Matter Foreign Body

Outcome

Nye was monitored in our ICU for the next 48 hours and the active suction was evacuated every 4 hours. She was maintained on pain medications and began eating the night after surgery. Once the drain was producing less than 1-2ml/kg/24hrs, the drain was removed and Nye was discharged to the owners. The culture yielded a Corynebacterium that was susceptible to Clavamox. Nye had a recheck appointment 2 weeks after surgery, the swelling has resolved and she was back to her normal activity level. The owners were very happy with her outcome.

Discussion

Plant awns are special in their design, allowing them to tunnel within soft tissues and body cavities. The barbed ends of the plant can imbed into the skin or be inhaled. Once inside the body, the plant material can tunnel into a body cavity or track along fascial planes. This material has been shown to be a source of pyothorax.

Foxtail plants are specifically found in the western half of the United States; however, there are numerous plants with similar barbed ends that can be located across the US.

It is possible given the Nye’s travel history and off leash activity in the woods that she could have inhaled this foreign plant material at some point in time. The barbs seen on this particular plant awn likely allowed it to burrow out of her lung lobe, creating the “spontaneous pneumothorax” she was diagnosed with and recovered from 1 ½ months prior to hospitalization at Hope. This plant awn then was buried within the soft tissues on the right side of her thorax, which created abscessation. If this material was not removed, she would have recurrence of the abscess and draining tracts due to the presence of the foreign material. It is important to remember that recurrent infections or chronic draining tracts may have an underlying foreign body present. If you have patients that have a draining tract that resolved with antibiotics therapy, but recurs when off of the antibiotics, there may be a foreign body within the tissues in the surrounding areas. It can be difficult to see this material on radiographs, so a focal ultrasound can be helpful, as it was in this case, for identifying the offending material.

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Priti Karnik, DVM, DACVS

Dr. Priti Karnik graduated Ross University School of Veterinary Medicine (RUSVM) in 2001. She completed her clinical year at Cornell University, later pursing an internship and then residency in small animal surgery at the Virginia-Maryland Regional College of Veterinary Medicine. In 2006, she became a Diplomate of the American College of Veterinary Surgeons.

Dr. Karnik was the Director of Surgical Services at Atlantic Coast Veterinary Specialists in New York from 2005 – 2007 and later moved to San Diego, California where she was a surgeon at an emergency and referral practice for four years. Dr. Karnik then returned to the east coast, although in a more tropical environment by returning to her Alma Mata as an Assistant Professor of Small Animal Surgery. She has lectured to students, taught surgical laboratories and was the referral surgeon for the Ross University Veterinary Clinic. Dr. Karnik’s close ties to the DC region and desire to be a part of a quality specialty practice have brought her to the Hope Center. Her surgical interest are extremely varied but her main goal is to provide the best care for her patients and owners.

Dr. Karnik’s four legged family consists of two rescued canines- a German Shepherd/Great Dane mix (Kai) and an island hound mix (King). In her free time, Dr. Karnik enjoys volunteering- she has delivered meals and worked with Kai as a therapy dog and loves being outdoors and hiking.

She has authored several scientific articles and has lectured at numerous continuing education events.

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